// μ = m // dayvan cowboy // music is math

After a period of mostly funny (except when racing thoughts outpaced myself, rendering me semi-catatonic) hypomania, I sunk into a mixed episode with marked strong dysthimic moments — to the point I couldn’t get out of bed from depression this wednesday.

I think this stems from my shrink wanting to wean me off of Seroquel (I had been so stable on Seroquel and lamotrigine for so long), starting rippling waves even after I resumed my normal doses of Seroquel. Still, his project is to wean me off the anticonvulsants this time, substituting them for more Seroquel and more Ritalin (I take the long-acting version for actual ADD, not as a pick-me-up pill) to compensate for the extra sedative effects.

The extra Ritalin has also an emergency antidepressant function here. Higher doses of Seroquel are supposed to kick in with an antidepressant effect, but my functioning was way too impaired by the severe dysthimic micro-episodes I was getting at random points of time. All in all, while I’m worried about the possible “flattening” effects of getting too far with Seroquel (we’re dosing it up 50mg at a time), the extra Ritalin did give me an extra kick while not giving me the full hypomania (racing thoughts, etc.) effect. At least not yet.

Current cocktail:

• 150mg Seroquel (dosing up 50mg at each check)
• 200mg Lamictal (have been tapering off from 300 for 10 or 12 days now)
• 20mg Ritalin LA + 10mg ordinary Ritalin (until my LA bottle is finished; then I’ll switch to 30mg Ritalin LA)
• 2mg clonazepam (my max dose was actually 4mg and I kicked off half of it because Ritalin made me calmer; I have some flexibility as for how much clonazepam to take)

20 packets transmitted, 20 packets received, 0% packet loss
Oh, cool, that means I have internet access. You wouldn’t believe how much downtime I get, specially on, wow, weekend nights, when I really need it.

My meds. Many people think medications are like drugs you take to help you cope instead of addressing the actual problem. The actual problem, of course, is the actual problem they have, because everyone seems to think every existential search is the same. Heck, dr. Freud thought every existential search was the same, and that’s why I was always distrustful of psychologists, even though my parents tried to force me into one (and managed to, for one consult) — they’d tell me what my existential search was. I was in my tweens, I had no friends, and that was the obvious guesstimate about what my existential search was, and they’d try to help me cope with something that was never really the problem. I’m just beginning to see what the problem is, and that’s because all the fucked up nonlinearity in my head is being sorted through — not the old nonlinearity that forms my memories, my personality and the fears I’m trying to address, but the new nonlinearities so I myself can keep up with my thinking and both search through my past and the problem, but also try and build a life from now on.

I’m currently taking an antipsychotic, an anticonvulsant, a benzodiazepine (which is actually a mild anticonvulsant whose side-effects everyone seeks) and a stimulant. First there’s Seroquel, which is quetiapine fumarate, but mentioning the generic name is pointless because it’s still patented. Then there’s lamotrigine, best known abroad for its original brand name before it went generic, Lamictal but I’ve really taking made-in-india Lamitor and made-in-Brazil Neural. Neural is such a stupid name for a med.

Stream of consciousness today — I apologize for the bad style. I fucked up big time when I  tried 10mg ritalin knowing I had skipped one dose of anticonvulsant. I had just run out and thought Seroquel was strong enough everything else was just an add-on. I think it’s a full hypomanic flip-out. I do know Ritalin competes with Seroquel for receptors. I’ve already taken six miligrams of clonazepam — which sure did chill me out — and two susie-Qs, and I’m still insomniac. Usually one 100mg seroquel will knock me out for 10-12 hours. 

I do hope the extra antipsychotic stops this on its tracks. If it doesn’t  I’m upping the anticonvulsant. But I don’t have the time for that, I’m supposed to function as a normal human being or get fired. 

On a second thought, I should up the anticonvulsant right now.  Maybe a Depakote, but if I’m depressed tomorrow I won’t be able to function. Lamictal has that antidepressant effect which could get in the way of stopping mania in its tracks. Maybe Risperdal?

Jesus, self-medicating is hard. I should have gotten an algorithm in case of a manic flip-out, but I wanted the Ritalin enough that I downplayed the pro-manic effects of it at my last season. 

What’s worse, as soon as I feel stabilized — no chaos attracting my brain even if ultrafocused on ritalin — I’ll still take ritalin, though in much more moderated amounts.

If the pre-psychotic “chaos attracting my brain” is the problem, I think I might do half a 2mg Risperdal. Seroquel is way too expensive to keep one-upping it in hopes of getting okay. OTOH a full 2mg Risperdal steals my entire soul. But hey, 1mg Risperdal plus 200mg Seroquel might be way too much antipsychotic and might numb my soul far worse than 2mg Risperdal did — even though Seroquel is much smarter.

What if Van Gogh was a mapmaker?

I bet he could put real art into those maps, but it wouldn’t really matter.

All the drugs I’ve taken for most of my psychiatric life — except for that brief contact with bupropion — have been anticonvulsants. And I’ve actually been okay, oscillating between mild hypomania and no hypomania at all. Remember, I started psychiatric drugs because of depression, which hasn’t happened for more than a night or two since I started treatment.

Then somehow I got into the (hypo)mania that wouldn’t stop. I’d take 6 or 8mg of clonazepam and still be awake all night. Spending massive amounts of money in luxury stuff like $250 headphones or a 160gb iPod. So we finally entered the strange world of atypical antipsychotics. I had learned a lot about anticonvulsants, but this is brave new world to me.

For a while I though they were horrible drugs that silence the chatter inside your head. 1.5mg o risperidone made me smart — as in shutting out all other stimuli that made it difficult to concentrate on the smarter stuff. 2mg made me a bot.

We’re phasing risperidone now and introducing Seroquel. Like with risperidone I’m quite liking the effect — which is very different — but I’m not at the final dose yet. OTOH, I’m still on risperidone, so I might be on the right track regarding antipsychotics.

I’m getting pleasure waves around 6PM everyday, and my first theory was that that could just be the Seroquel (which has a half-life of 7 hours only) wearing off and leaving the 4mg clonazepam that’s still on my daily cocktail. But, hey, I’m on minimal doses of Seroque, and that’s supposed to hit your H1 receptors first, which could mean I’m only getting a sedative — or maybe it’s enough for the antipsychotic effect to kick in — and no one in the world can tell. And I’m on risperidone as well.

Há algum tempo que a visitação ao meu blog journal tem sido movida em boa medida por buscas muito dirigidas por informação no Google, o que não chega a ser curioso (dado que eu uso muitas frases estatisticamente improváveis) mas é desafortunado, porque eu não dou realmente nenhuma informação útil. Mas como alguns temas têm se repetido consistentemente nos termos de busca (segundo as estatísticas do Wordpress) ao longo dos últimos meses, decidi tirar uma meia hora para um pingue-pongue com toda essa gente anônima que não pode nem deixar comentários.

“torval efeitos colaterais” Torval é um equivalente genérico da versão de liberação prolongada do Depakote. Eu já tomei Torval 1500, e como estava partindo as minhas pílulas recebi uma receita para o Depakote brand-name, que sairia mais barato porque a pílula partida perde o efeito de liberação prolongada. E, enfim, muito mais gente tomou o Depakote e sabe como isso pode dar efeitos colaterais horríveis. Mas olha, eu tomei doses bem baixas — primeiro 1500, e depois 750, para o meu peso que na época era de uns 70 quilos — complementando o regime básico de lamotrigina (Lamitor, Neural, Lamictal, etc.). Eu não tive o famoso Efeito Velhice de perder cabelo, ficar cansado com os ossos doendo, etc. etc. Pra mim o Torval foi um ansiolítico extremamente intenso, ao ponto que eu passei um mês inteiro fora do planeta, feito um monge budista, em despersonalização completa (o que provavelmene se deve às minhas questões neurológicas esquisitinhas também).

Mas, respondendo à questão dos efeitos colaterais negativos, uma coisa muito marcante da época do Torval é a perda de memória.Eu não lembro de quase nada daquele mês, e com freqüência eu não lembrava de conversas tidas horas antes, ou de tarefas cumpridas na semana anterior. Recentemente eu tive que conferir alguns cálculos feitos aquela época para o trabalho, e fui ver os logs do Stata: eu refiz os mesmos cálculos várias vezes — cheguei ao número errado várias vezes, lembrava de que havia algo de errado com aquele número embora não conseguisse recordar o que, refazia o cálculo com outra metodologia de ponderação e encontrava o número que eu queria, o número que existia como uma imagem fuzzy na minha cabeça — sem nem mesmo pensar que tudo existia no log.